Provider Demographics
NPI:1598922411
Name:J JAMES AGRUSA, P.C.
Entity Type:Organization
Organization Name:J JAMES AGRUSA, P.C.
Other - Org Name:AGRUSA CHIROPRCATIC CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:AGRUSA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-263-5611
Mailing Address - Street 1:16651 21 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-2603
Mailing Address - Country:US
Mailing Address - Phone:586-263-5611
Mailing Address - Fax:586-263-5130
Practice Address - Street 1:16651 21 MILE RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-2603
Practice Address - Country:US
Practice Address - Phone:586-263-5611
Practice Address - Fax:586-263-5130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004758111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1771391Medicaid
MI1771391Medicaid
MI0E05155Medicare PIN